Apraxia of speech (AOS) is a disorder in programming the speech musculature to produce the correct sounds of words in the proper sequence. Pure AOS without other speech-language deficit is very rare. We report a patient with AOS without aphasia developed after the left insular infarction. For the case of impaired speech production, AOS should be recognized as a differential diagnosis. Correct diagnosis and early institution of speech therapy may have important implications in the prognosis of AOS.
Aphasia ; Apraxias* ; Diagnosis ; Diagnosis, Differential ; Humans ; Infarction* ; Prognosis ; Speech Therapy

Aphasic syndromes from diseases such as stroke and degenerative disorders are still common and disabling neurobehavioral disorders. Diagnosis, management and treatment of these communication disorders are often dependent upon understanding the neuropsychological mechanisms that underlie these disorders. Since the work of Broca it has been recognized that the human brain is organized in a modular fashion. Wernicke realized that the types of signs and symptoms displayed by aphasic patients reflect the degradation or disconnection of the modules that comprise this speech-language network. Thus, he was the first to propose a diagrammatic or information processing model of this modular language-speech network. Since he first published this model many new aphasic syndromes have been discovered and this has led to modifications of this model. This paper reviews some of the early (nineteenth century) models and then attempts to develop a more up-to-date and complete model.
Aphasia* ; Automatic Data Processing* ; Brain ; Communication Disorders ; Diagnosis ; Humans ; Stroke

The purpose of this study was to assess the clinical applicability of a form of aphasia test, the Korean Test Form 1, which is adapted for use in Korea from the test for Differential Diagnosis of Aphasia (The Roken Test) in Japan. The Korean Test Form 1 was applied to 40 aphasics and 40 normal controls, and the following results were obtained: 1. The aphasic group showed significantly low mean score in every subtests as well as total scores compared with the normal controls. 2. There was a tendency for relatively higher scores in the subtests of numbers and calculation than those of speech performance in patients with aphasia. 3. The types of aphasia were determined in 34 (85%) of 40 aphasics by the Korean Test Form 1 : showing 5 persons with amnestic aphasia, 7 with Broca's aphasia, 15 with Wernicke's aphasia and 7 with global aphasia. Therefore, we concluded that this Korean Test Form 1 would be clinically valuable for the differential diagnosis and the classification of aphasia in Korea.
Aphasia* ; Classification ; Diagnosis, Differential ; Humans ; Japan ; Korea ; Neuropsychological Tests*

Primary progressive aphasia (PPA) is classified into agrammatic, semantic, and logopenic variants, but differential diagnosis is often challenging. There is accumulating evidence that the neuropathology of logopenic PPA is distinct from that of the other types. We report herein a woman with logopenic PPA who was diagnosed by clinical, neuropsychological, and radiologic data during 2 years of follow-up. Interestingly, her cerebrospinal fluid biomarkers were found to be similar to those found in Alzheimer's disease, with a decreased concentration of Abeta42 and an increased concentration of pTau181 (tTau).
Alzheimer Disease* ; Aphasia* ; Aphasia, Primary Progressive ; Biomarkers* ; Cerebrospinal Fluid* ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Semantics

Primary progressive aphasia (PPA) is a heterogenous neurodegenerative disorder characterized by declining language and speech ability. Various underlying neuropathologies can induce PPA, and the disorder is divided into three subtypes—progressive non-fluent aphasia, semantic variant aphasia, and logopenic aphasia—according to clinical features. Accurate disease classification and prediction of underlying diseases are necessary for appropriate treatment, but proper use of imaging tests is important because clinical information alone often makes it difficult to make accurate decisions. Because there is a characteristic metabolic pattern according to the subtypes, F-18 fluorodeoxyglucose positron emission tomography (PET) can indicate subtype classification. In addition, PETstudies for imaging amyloid or dopamine transporters play an important role in demonstrating underlying disease. The present case showed that PET imaging studies are useful in diagnosis and could be used as a biomarker in PPA.
Amyloid ; Aphasia ; Aphasia, Primary Progressive ; Biomarkers ; Classification ; Diagnosis ; Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Electrons ; Neurodegenerative Diseases ; Neuropathology ; Positron-Emission Tomography

OBJECTIVE: Seizures are common consequence of traumatic brain injury and have been reported in clinical series as an incidence of 15% to 22%. Among them, nonconvulsive seizures (NCS) are often unrecognized during the early period of neurosurgical hospitalization because their clinical presentations can be misunderstood as consequent symptoms of clinical course, and the diagnosis can be confirmed only by the electroencephalographic (EEG) recording. METHODS: We retrospectively reviewed our clinical database of traumatic brain injury (TBI) patients admitted between March 2008 and September 2012. Twenty one patients with suspicious symptoms of NCS, such as decrease of consciousness, aphasia or irritability, were included. Routine wake and sleep EEG or bedside continuous EEG monitoring were done in all patients. RESULTS: Ten out of twenty-one patients showed abnormal activities on EEG. Ictal discharges were documented on four patients. Based on clinical symptoms and EEG findings, these four patients were diagnosed as NCS. Two out of four NCS patients showed EEG findings of nonconvulsive status epilepticus (NCSE). Another six patients with abnormal EEG activities were considered as 'suspicious NCS' because only interictal activities were recorded on EEG but increasing dose or adding on antiepileptics relieved their symptoms. All NCS/NCSE were successfully controlled by appropriate antiepileptic therapy. CONCLUSION: Our result showed that NCS was diagnosed in about 20% of patients with suspicious symptoms. There's a possibility that actual NCS might have happened more. Because untreated NCS/NCSE might cause worse clinical outcome, careful observation and urgent EEG recordings should be considered in a patient with suspicious NCS symptoms.
Anticonvulsants ; Aphasia ; Brain Injuries* ; Consciousness ; Diagnosis ; Electroencephalography ; Hospitalization ; Humans ; Incidence ; Retrospective Studies ; Seizures* ; Status Epilepticus

Twenty patient's capsular lesions were detected by high resolution brain computed tomograhpy (CT). Eighteen of them had systemic hypertension. Two patients had prior stroke episodes that were of the same nature. All of the patients had sudden onset of neurologic deficits. Their neurologic syndromes were pure motor stoke (10 cases), ataxic hemiparesis (3 cases), pure motor stroke with dysphasia (1 cases), pure sensory-motor stroke (3 cases), pure motor stroke with tremor, locked-in syndrome, and hemiparesis with latered consciousness, each 1 case respectively. The CT showed capsular infarcts of ovolid or round hypodense lesion that was smaller than 20mm in diameter and that was seen on only two scan sections. The sites of capsular infarcts were genu(5 cases), posterior limb (9 cases), genu-posterior limb (3 cases), genu-anterior limb (3 cases), and anterior limb (4 cases) respectively. Large capsulo-putamino-caudate infarcts, or giants lacunes (type 1 of Rascol et al ) are seen in 3 cases only in pure motor stroke ; Posterior limb capsular Iacunes (type 2 of Rascol et al), 6 cases in pure motor stroke, 3 cases in ataxic hemiparesis, 2 cases in pure sensory-motor stroke, 1 case in modified pure motor stroke with tremor : Anterior capsular lacunes (type 3 of Rascol et al), 1 case in pure motor stroke, 1 case in modified pure motor stroke with dysphasia, 1 case in modified pure motor stroke with memory and cognitive dysfunction. None of the capsular infarct caused mass effect. In five cases there was a relatively complete neurologic improvement, in 14 cases did the patients show mild residual neurologic deficit, and one patient expired. With the use of CT, the diagnosis of capsular infarcts has moderately increased.
Aphasia ; Brain ; Consciousness ; Diagnosis ; Extremities ; Humans ; Hypertension ; Memory ; Neurologic Manifestations ; Paresis ; Quadriplegia ; Stroke ; Tremor

BACKGROUND: Recent therapeutic advances to delay the progression of dementia have renewed calls to improve early detection and management of individuals with dementia. A new computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS) was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia, its subtype, depression and delirium, to present reference diagnoses just after completion of tests, and to detect early dementia. This study aims to verify the diagnostic capability of the CARDS. METHODS: The CARDS was administered to 56 dementia patients (38 Alzheimer's disease, 18 vascular dementia) as well as 40 nondemented subjects. To evaluate the sensitivity and specificity of the CARDS, we compared the CARDS diagnosis with the clinician's diagnosis on dementia, Alzheimer's disease, vascular dementia and depression. To test diagnostic capability of the CARDS in the diagnosis of early dementia, we compared mean scores of total and subscales in the CARDS of GDS stage 3 group with those of GDS stage 4 group. RESULTS: The CARDS demonstrated high levels of sensitivity and specificity in the diagnosis of dementia, AD, VaD and depression. Mean CARDS scores for total and 3 subscales (amnesia, aphasia, agnosia) in GDS stage 3 group were significantly different from those of GDS stage 4 group (p<0.001). CONCLUSION: We demonstrated that CARDS is valid instrument not only for dementia diagnosis but also for detection of early dementia.
Alzheimer Disease ; Aphasia ; Delirium ; Dementia ; Dementia, Vascular ; Depression ; Diagnosis* ; Humans ; Sensitivity and Specificity

BACKGROUND & PURPOSE: Ideomotor apraxia is a gestural deficit which is not due to primary sensory or motor deficit, poor auditory comprehension or incooperation. Previous studies on apraxia in AD patients include advanced AD patients who exhibited marked impairment in auditory comprehension, This might have confounded the results of the studies. The purpose of this study is to observe the frequencies and patterns of gestural errors in the early stage of AD. METHOD: Eighteen patients with AD (M : F = 4 : 14, age 62.6 + 7.2) and eighteen age- and sex- matched controls participated in this research. Patients who scored below 80 % of Western Aphasia Battery comprehension subtest and showed marked cognitive impairments were excluded (MMSE; 19.9 + 4.4, CDR 1.1+/- 0.5). Gestures. In response to commands were videotaped and analyzed by 2 neurologists and 1 speech-language pathologist. Test items included 3 types of movements ; 10 limb intrasitive, 15 transitive, and 10 buccofacial. RESULTS: Limb transitive movements were the most affected while buccofacial was the least. The error patterns most frequently observed were body-part-as-objects (BPO, 20%), external configuration orientation (ECO, 16%), and movement error(M, 9%). In comparision, BPO, ECO, M errors in normal control were 2%, 3%, and 4% respectively. In addition, apraxia item, which are to detecting AD were identified. CONCLUSION: It is suggested that the apraxia is commonly associated with AD even in the early stage of the disease and an accurate anaIysis of errors may contribute to establishing an early diagnosis of AD.
Alzheimer Disease* ; Aphasia ; Apraxia, Ideomotor* ; Apraxias ; Comprehension ; Early Diagnosis ; Extremities ; Gestures ; Humans

BACKGROUND: Alcohol dependence and Alzheimer's disease induce cognitive dysfunction in common. However, the cognitive dysfunction from alcohol dementia can be improved with appropriate treatment while that from Alzhimer's disease is usually irreversible and progressive. Nevertheless, the discrete diagnosis for the cause is delicate or sometimes impossible in those patients showing both characteristics of alcohol dementia and Alzhimer's disease. Thus, we investigated the feasibility of the computerized comprehensive neuropsychological test, Cognitive Assessment and Reference Diagnoses System(CARDS), to differentiate the diagnoses between alcohol dementia and Alzhiemr's disease in their early stages. METHODS:32 elderly subjects with cognitive dysfunction were recruited. They are divided by two groups; 16 subjects with alcohol dependence and 16 subjects without alcohol dependence(as early Alzhiemr's disease) We assessed the cognitive dysfunctions of each group using CARDS. The subscales of the CARDS include; (1) Amnesia, (2) Aphasia, (3) Apraxia, (4) Dysexecution, (5) Attention/Calculation. RESULTS: Alcohol dependence group showed lower mean score in amnesia subscale, but showed higher mean scores in apraxia and dysexcution subscales than early Alzheimer group. And both groups didn't show significant differences of mean scores in agonisa, aphagia, and attention/calculation subscale. CONCLUSION: In summary, this study shows that the elderly patients with alcohol dependence have cognitive deficits mainly in the amnesia domain of CARDS assessment, whereas early Alzhiemr's disease patients show equal or worse cognitive function in other domains except amnesia. Thus, we suggest that CARDS will be helpful to differentiate alcoholic dementia and Alzhiemr's disease in their early stages.
Aged* ; Alcoholics ; Alcoholism* ; Alzheimer Disease* ; Amnesia ; Aphasia ; Apraxias ; Dementia ; Diagnosis* ; Humans ; Neuropsychological Tests